Palliative care helps lung cancer survival

Palliative care, which helps the gravely ill makethe most of the time they have left, provided terminal lung cancer patients with moretimeto enjoy, a U.S.study found.

Thestudy found that patients who started soon aftertheir diagnosis on palliative care along with usual cancercare lived nearly three months longer than people given onlystandard cancer care, even though this second group had more chemotherapy.

'One of the most common misconceptions about palliative care is that it indicates treatment has failed.' Dr. Vicki Jackson

That's a big difference. Patients like this typicallylive less than a year after diagnosis, said study leader Dr.Jennifer Temel, a cancer specialist at Massachusetts GeneralHospital in Boston, where the study was done.

The results, in Thursday's New England Journal of Medicine, could affect the care of a lot of people: More thanhalf of lung cancer patients have incurable disease by the timethey are diagnosed.

Palliative care involves doctors, nurses, socialworkers, nutritionists and even chaplains who specialize in pain control and treating nausea, shortness of breath and other symptoms that affect quality of life. It's not the same as hospice orcomfort care, when doctors think a patient has less than six months tolive and treating the illness no longer helps.

The study was one of the best tests yet of palliative care, and the results should ease many fears about starting it soon after diagnosis, doctors say.

"One of the most common misconceptions aboutpalliative care is that it indicates treatment has failed, that it means giving up,"said Dr. Vicki Jackson, actingchief of palliative care at Massachusetts General.

The study involved 151 people newly diagnosed with cancer that had spread beyond the lung.

All received routinecancer care and about half also got palliative care.

Better quality of life

More than half of those on standard care alonereceived chemo in their last two weeks of life, versus only one-third of thepalliative care patients. Yet the palliative care group'smedian survival was better: more than 11 months versus less than ninemonths.

Quality of life and physical functioning improved inthe palliative care group and worsened in the others.Depression was less than half as common in the palliative caregroup.

"When people feel better, they're much more likelyto go for their treatment, to get up out of bed, to exercise,"and that affects survival, said Dr. R. Sean Morrison, president of the American Academy of Hospice and PalliativeMedicine and a doctor at Mount Sinai School of Medicine in New York.

Dr. Gail Austin Cooney knows this from personal and professional experience. Cooney, past president of the academy and assistant medical director of the Hospice of Palm BeachCounty in Florida, used palliative care to cope with a particularly difficult chemo treatment for advanced ovarian cancer in 2008.

"I knew that in order to tolerate the treatment I needed to have my symptoms controlled and be in the bestphysical and psychological state. I wanted to get all thosetreatments they told me I wouldn't be able to finish," said Cooney,whose cancer is now in remission.

The study shows that palliative care should be aroutine part of managing any serious illness rather than "what wedo when there is nothing more that we can do," Amy Kelley andDiane Meier, both doctors at Mount Sinai, wrote in an editorial in the journal.

The American Society of Clinical Oncology andtwo cancer charities paid for the study. It did not look at the cost of palliative care, which is mostly doctor visits.However, research Morrison has published suggests it can savemoney by lowering emergency visits, unwanted hospital stays and futile treatments.

Despite the benefits of palliative care to patients and their families, 75 to 85 per cent of the 160,000 Canadians who die from terminal illnesses each year don't have access to it during the end-of-life stage, according to statistics from a Senate report published in 2000 and the Canadian Hospice Palliative Care Association.